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SYMTOMPS AND SIGN OF THE CARDIAVASCULAR

HISTORY TAKING AND PHYSICAL DIAGNOSIS OF THE CARDIVASCULAR ALL ASPAR MPPAHNYA

MEDICAL HISTORY TAKING IN CARDIAVASCULAR GOALS A. Establish rapport with the patient B. Obtain diagnostic information about the patient 1. pertinent information that may lead to the establishment of diagnosic 2. Asses the severity of the problem. 3. Determine other sorces of information. 4. Asses the patient`s personality traits 5. Asses the patient`s level of understanding 6. Asses the patint`s personal goals and requirements with regard to activity

CHARECTERIZATION OIF SYSTEM

A.Patients can have heart disease without symtomps,or they can have symptoms that may be associated with noncardiac diseases B.The characteristic features of all symtomps should be obtained in detail to provide the maximum information.Questioning about each symptoms (e.g.,chest pain ) should include :

1. 2. 3. 4. 5.

Location and radiation Quality Quantity (severity,frequency and duration) Chronology (onset and development) Setting and recurrence (time of day,activity,and emotional state) 6. Aggravating and alleviation factors 7. Associated symptoms 8. Aesponse to any particular medication

THE SYMPTOMS MOST FREQUENTLY EXPERIENCED BY PATIENTS WITH CARDIOVASCULAR DISEASE : 1. CHEST PAIN 2. PAIN IN THE EXTREMITIES 3. DYSPNEA 4. PALPITATIONS 5. SYNCOPE,NEAR SYNCOPE OR DIZZINES 6. FATIGUE 7. HEMOPTYSIS 8. CYANOSIS 9. EDEMA (ANKLE EDEMA)

CHEST PAINT
A.ANGINA PECTORIS 1. AP is characterized by paroxysmal attacks of chest discomfort that occur when coronary blood flow is inadequate to meet the metabolic demands of the hearts. 2. The pain occurs retrosternally and frequently radiates into the neck,jaw,and upper exterminates.it often radiates across the precordium to yhe left shoulder and upper arm. 3. Angina is usually described as being dull and constant.it has been described as constricting,boring,pressing,or expanding.it

also often expressed as a burnig sensation,indigestion or heatburn. 4. The pain maybe mild to excruciating,and occurs with variable frequency. 5. Attackas of angina pectoris usually last only a few minutes.sublingual nitroglycerine usually relieves the pain within 3 minutes. 6. The attacks usually occur during physical exertion,emotional stress,exposure to culd weather,or following meals.the pain may occur at rest (angina decubitus )or awaken the patient from sleep (nocturnal angina) 7. Tnginal pain may be accompanied by palpitation,dizziness,and nausea. 8. Angina accoring with increasing frequency or severity has been referred to as unstable angina or crescendo angina and this type of angina often occurs even at rest. 9. Coronary artery spasm may occur with or without fixed coronary artery lesions.the pain like this occurs at rest ratherthan with mild exertion or emotional exciterment.it frewquently occurs during the night,awakening thr patient from sleep 10.When an anginal attack is not delieved by rest and two and more sublingual nitroglycerine,suspect inpending myocardinal infarction (MI) and treat the patientin the coronary care unit until diagnosis is proven otherwise.

B.MYOCARDINAL INFARCTION The pain of MI differs from that of AP in several ways : 1. Severity : it usually more severe 2. Duration : the pain can persist for hours and occasionally,as a mild distcomfort,preasure sensation,or sereness,for 1 and 3 days or even longer. 3. Relationship to activity : it usually occurs at rest. 4. Response to nitrolycerine : the pain is usually not relieved by this medication.

5. Associated to other symtomps : chest pain is frequently associated with various over serious manifestation of cardiogenic shock,acute congestive heart failure (CHF),and life-thereatening cardiac arrhythmias. C. PERICARDITIS 1. The pain in sharp and frequently severe 2. It is located precordially and may radiate into the soulder and neck. 3. It is exacerbated by taking a deep breath or turning from side to side.leaning forward my lessen the chest discomfort. 4. The nature of chest pain and other associated findings my vary considerably,depending upon the underlying disorders (e.g. viral pericarditis,bacterial pericarditis,post myocardinal infaction syndrome,postcardiotomy syndrome,uremy pericarditis,pericarditis associated with malignancy,tuberculous pericarditis,etc)

D. MYOCARDITIS AND CARDIOMYOPATHIES 1. Myocarditis and cardiomyopathies my cause chest pain,depending upon the underlying disorder. 2. Myocarditis is often associated with pericarditis and the chest pain under the circumstances is usually similar,if not identical,to pain inpure pericarditis. 3. Chest pain and even electrocardiographic findings of cardiomyopathies may closely resemble acute MI.

E. PULMONARY EMBOLISM 1. Most small pulmonary emboly produce little or no chest pain. 2. The of pulmonary embolism is usually sharp,begins suddenly,is aggravated by breathing.

3. It is usually accompanied by significant dyspnea. 4. A history of rtecent surgery,pregnancy,trauma,bed rest,prolonged sitting or standing,or use of oral contraceptives (often associated with smoking) may help in making the diagnosis. F. DISSECTION OF THE AORTA 1. the pain sharp,sudden,excruciating,and most severe at the onset.it is often described as tearing,or ripping. 2. its location is in the anterior chest,but it frequently radiates into the back or the abdomen. 3. it is not aggravated by breathing 4. symptoms of vascular occlusion frecuently follow F MYRAL VALVE PROLPASE SYNDROME (BARLOW`S SYNDROME) 1.Chest pain associated with MVP syndrome is usually sharp,brief,unrelated to exertion,and located near the apex or left lateral chest. 2.it may be associated with palpitation, dyspnea, fatigue, and dizzy spells. 3.it may mimic the pain of AP or MI , but it usually produces atypical chest pain. G.PSYCHONEUROTIK PROBLEMS 1. various psychoneurotic disorders frequently produce atypical chest pain